NURS 3 - Mod 1 Victims of violence (Med Surg) EAQ's

In which of the following situations is the nurse legally obligated to report elder mistreatment (EM)? Select all that apply. 1 Actual EM 2 Abandonment 3 Suspected EM 4 Patient request 5 Inability to purchase prescriptions 6 Family unable to care for the older adult

1 - Actual EM 2 - Abandonment 3 - Suspected EM 4 - Patient request Actual EM, a patient request, patient abandonment, and suspected EM are all subject to mandated reporting to Adult Protective Services. Social services and/or a caseworker can assist an older adult with the purchase of prescriptive medications and assist with placement of the patient when a family is unable to care for the patient.

An elderly patient is brought from home with bruising on both upper arms and appears lethargic. The nurse suspects elder mistreatment (EM). Which agency must be notified of the suspected abuse? 1 Adult Protective Services 2 Hospital security department 3 Food and Drug Administration 4 Local domestic abuse shelter

1 - Adult Protective Services In most states, Adult Protective Services must be notified of suspected EM. The hospital security department, Food and Drug Administration, and local domestic abuse shelter do not need to be notified.

Which assessment findings would alert the nurse to possible elder mistreatment? Select all that apply. 1 Agitation 2 Depression 3 Weight gain 4 Weight loss 5 Hypernatremia

1 - Agitation 2 - Depression 4 - Weight loss 5 - Hypernatremia Agitation and depression may be manifestations of psychologic abuse or neglect. A loss of body weight, rather than weight gain, is another clinical manifestation of physical neglect. Hypernatremia may signify dehydration caused by physical neglect.

Elder mistreatment (EM) may occur in what settings? Select all that apply. 1 Community hospital 2 Rehabilitation facility 3 Senior citizens center 4 Long-term care facility 5 Home of the elderly patient

1 - Community hospital 2 - Rehabilitation facility 4 - Long-term care facility 5 - Home of the elderly patient Elder mistreatment may occur in community hospitals, rehabilitation facilities, long-term care facilities, and private homes. It is unlikely to occur in senior citizens centers.

Which factors place the older adult at a higher risk for elder mistreatment (EM)? Select all that apply. 1 Dementia 2 Depression 3 Active lifestyle 4 Caregiver respite 5 Decreased social support 6 Inability to perform activities of daily living (ADLs)

1 - Dementia 2 - Depression 5 - Decreased social support 6 - Inability to perform activities of daily living (ADLs) Dementia, the patient's inability to perform ADLs, depression, and decreased social support contribute to increased risk of EM. An older adult with an active lifestyle and caregiver respite are preventive factors that decrease the risk of mistreatment.

While working at a home care agency, the nurse visits a 79-year-old male patient for a non-healing leg ulcer. The patient has a history of diabetes; is alert; and is oriented to person, place, and time. He resides with his son, who is unemployed. The nurse notes the patient is unbathed and emaciated. The leg ulcer dressing is saturated with fluid. Skin turgor is decreased and a urinal on the table contains dark, concentrated urine. When questioned about his fluid intake, the patient states how lucky he is to have a son to care for him at home. What is the most likely reason for the patient's lack of acknowledgment of his fluid intake? 1 Fear of being abused by his son 2 Unable to ambulate to obtain water 3 Suffering from dementia and delirium 4 Unaware of his surroundings and care

1 - Fear of being abused by his son Fear of being abused by his son is a likely a concern of the patient. He has multiple healthcare needs that are not being met, but he may not want to cause any issues that may lead to verbal or physical abuse or abandonment to a nursing home. The patient may not be able to ambulate to get water, but further assessment needs to be done to determine this. The patient is aware of his surroundings and care as he is alert and oriented to person, place, and time. He does not appear to suffer from dementia or delirium.

An older adult who is admitted with unexplained injuries, appears withdrawn, and is ambivalent in the presence of the caregiver may be experiencing what type of elder mistreatment? 1 Neglect 2 Sexual abuse 3 Abandonment 4 Violation of personal rights

1 - Neglect An older adult who is admitted with unexplained injuries, appears withdrawn, and is ambivalent in the presence of the caregiver may be experiencing neglect. Abandonment is characterized as the desertion of an older adult. Sexual abuse is nonconsensual sexual contact. Violation of personal rights occurs when the older adult is denied the right to privacy or right to make decisions regarding living arrangements.

An older adult is brought into the emergency department by a family member who has been providing care for the patient at home. Upon physical assessment, the nurse notes that the patient has bilateral bruising on the arms in various stages of healing. Significant laboratory results include an increased hematocrit, increased serum sodium, and decreased serum protein. Furthermore, the patient states, "They take all of my money and threaten to send me to a nursing home." What type of elderly mistreatment (EM) will the nurse document? Select all that apply. 1 Neglect 2 Abandonment 3 Physical abuse 4 Financial abuse 5 Psychologic abuse 6 Violation of personal rights

1 - Neglect 3 - Physical abuse 4 - Financial abuse 5 - Psychologic abuse The patient is experiencing financial abuse and exhibits signs of psychologic abuse, neglect, and physical abuse, all of which are characteristics of EM. A violation of personal rights occurs when the older adult is denied a right to privacy or a right to make a decision regarding health care and living arrangements or experiences a forcible eviction. Abandonment is characterized by desertion.

An older adult is admitted to the emergency department with findings of non-life-threatening injuries consisting of extensive bruising, skin excoriations, and pressure sores. Elder mistreatment is suspected, and photographs are needed to document the injuries. Prior to taking the photographs, which action takes priority? 1 Obtaining consent 2 Bathing the patient 3 Treating the patient 4 Notifying Adult Protective Services

1 - Obtaining consent Consent must be obtained prior to taking photographs to document physical findings of suspected abuse or neglect. If possible, this should be done prior to treating or bathing the patient. Adult Protective Services should be notified following immediate care of the patient.

The nurse is performing an admission assessment for an 87-year-old patient cared for by the patient's daughter, who works fulltime and has three young children. The daughter shows the nurse the patient's prescription medication bottles. The nurse notes most of the pills are still remaining in the prescription bottles with expired dates. Which situations might the nurse suspect? Select all that apply. 1 Possibility of elder mistreatment (EM) 2 Lack of insurance to refill the medications 3 Patient refusal to take medication as ordered 4 Sharing of medication with other family members 5 Concern for safety of young children around medications

1 - Possibility of elder mistreatment (EM) 3 - Patient refusal to take medication as ordered The possibility of elder mistreatment (EM) exists, as the daughter may be too busy with work and family obligations to adequately care for the parent. The nurse needs to do further assessment to determine if the patient is refusing to take medications as ordered. Lack of insurance is not noted in this case scenario. Safety of young children is a concern, but nothing in this case scenario leads the nurse to believe it is an issue. Young children would be likely to try eating medications, resulting in lower, rather than higher, pill counts. Sharing of medication with other family members would also result in lower pill counts.

An elderly patient is admitted from home with an infected pressure sore. What will the nurse include during the assessment of this patient? 1 Screening for mistreatment 2 Development of a safety plan 3 Notifying the health care provider 4 Asking the caregiver what happened

1 - Screening for mistreatment Assessment should include screening the patient for elder mistreatment (EM). Developing a safety plan should be initiated if the patient appears to be in immediate danger. The health care provider should be notified of the assessment findings so the proper treatment can be initiated. The caregiver may be interviewed after a thorough screening and head-to-toe assessment is completed.

Which may be assessment findings of sexual abuse in an older adult? 1 Sexually transmitted infection 2 Anal bleeding from hemorrhoids 3 Use of lubricant during intercourse 4 Vaginal bleeding after a Papanicolaou smear

1 - Sexually transmitted infection Sexually transmitted infections may be a sign of sexual abuse due to the abuser's sexual habits. Anal bleeding would be an expected finding from hemorrhoids. Use of lubricant may be normal in older adults due to vaginal dryness after menopause. Vaginal bleeding may be related to a Papanicolaou smear.

What is underuse of medication in the older adult that is hospitalized considered? 1 Domestic violence 2 Nursing judgment 3 Routine plan of care 4 Elder mistreatment (EM)

4 - Elder mistreatment (EM) Overuse or underuse of medication in the older adult is considered EM. Domestic violence occurs in as a result of a family member or partner abusing or neglecting the patient. Underuse of medication is not included in a routine plan of care, nor is it an appropriate nursing judgment to intentionally alter the medication dose ordered for a patient.

Which of the following factors puts an older adult at risk for elder mistreatment (EM)? 1 Retirement 2 Alcohol abuse 3 Immigration status 4 Financial independence

2 - Alcohol abuse Alcohol abuse is one of the identified risk factors for elder mistreatment (EM). Financial independence and retirement are social factors that do not increase the risk of EM. Immigration status is not a risk factor for EM, but it may be a factor in underreporting the abuse.

Which factors put an older adult in a long-term care setting at a higher risk for elder mistreatment (EM)? Select all that apply. 1 Smoking 2 Alcohol use 3 Physical limitations 4 Ethnic background 5 Cognitive limitations 6 Inability to perform activities of daily living (ADLs)

2 - Alcohol use 3 - Physical limitations 5 - Cognitive limitations 6 - Inability to perform activities of daily living (ADLs) The older adult in a long-term care setting has the same risk factors for EM as the community-dwelling older adult. Risk factors include cognitive and physical limitations, inability to perform ADLs, and alcohol use. Smoking and ethnic background are not identified risk factors for EM in long-term care settings.

What factor(s) place older adults at greater risk for elder mistreatment (EM)? 1 Increased social support 2 Dementia and depression 3 Pneumonia and heart failure 4 Ability to perform activities of daily life (ADLs)

2 - Dementia and depression Dementia and depression place older adults at risk of elder mistreatment (EM), as the behaviors associated with these diagnoses increase the difficulty of caring for the patient. Ability to perform ADLs decreases the level of care needed and the incidence of EM. Increased social support helps to relieve some of the burden of care needed; this generally decreases the incidence of EM. Pneumonia and heart failure are not noted as risk factors increasing the incidence of EM.

An older adult patient is admitted for injuries caused by abuse from the person with whom he or she resides. What type of mistreatment or abuse does the nurse document? 1 Family 2 Domestic 3 Community 4 Institutional

2 - Domestic The older adult who is being mistreated or abused by a person who resides with him or her is experiencing domestic abuse. Institutional mistreatment or abuse occurs in settings such as a hospital, long-term care facility, or nursing home. Mistreatment in the community may occur at a church or a recreation facility. The perpetrator who lives with the patient is not always necessarily a family member.

What are the signs of physical abuse? 1 Desertion of an older adult at a hospital 2 Multiple injuries at various stages of healing 3 Depression, agitation, and withdrawn behavior 4 Bruised breasts and unexplained vaginal or anal bleeding

2 - Multiple injuries at various stages of healing Physical abuse is associated with slapping, striking and restraining. Therefore it can be identified by the presence of bruises, bilateral injuries on the wrists and ankles, and injuries at various stages of healing. Depression, agitation, and withdrawn behavior are signs of psychologic abuse. Leaving an older adult at a hospital is abandonment. Bruised breasts or unexplained vaginal or anal bleeding are manifestations of sexual abuse.

During a follow-up visit, the nurse assesses that an older patient has repeated injuries on ankles and wrists that are at various stages of healing. What should the nurse infer from this finding? 1 The patient is experiencing sexual abuse. 2 The patient is experiencing physical abuse. 3 The patient is experiencing financial abuse. 4 The patient is experiencing psychologic abuse.

2 - The patient is experiencing physical abuse. A patient who is experiencing physical abuse will show bruises and repeated bilateral injuries such as ankles and wrists at various stages of healing. A patient suffering sexual abuse would have unexplained vaginal and anal bleeding, but not injuries on the wrists and ankles. Repeated injuries on the ankles and wrists do not indicate financial abuse of the patient. Psychologic abuse includes berating verbally and giving threats of punishments, but will not manifest in physical injuries.

A nurse finds out that a patient who is admitted to the nursing home is a victim of physical and verbal abuse. What are the steps that the nurse should undertake upon such a discovery? Select all that apply. 1 Call a lawyer for the patient. 2 Confront the family and caregiver. 3 Document the patient's statement. 4 Collect evidence such as blood-stained clothes and sheets. 5 Take pictures of injured body areas after obtaining the patient's consent.

3 - Document the patient's statement. 4 - Collect evidence such as blood-stained clothes and sheets. 5 - Take pictures of injured body areas after obtaining the patient's consent. When the nurse finds out about the physical and verbal abuse of a patient, the nurse should collect and preserve all evidence that can prove abuse, such as clothing, sheets, and dressings. The nurse should take pictures of affected areas with the patient's consent and document all statements made by the patient related to being abused. The pictures and the documents would serve as evidence to mistreatment. Calling a lawyer would not be appropriate because it should first be reported to legal agencies. The nurse should not confront the family accused of abuse; it should be reported to legal agencies.

Who is responsible for the majority of reported elder mistreatment cases? 1 Hospital staff 2 Adult day care 3 Family members 4 Home health aides

3 - Family members Family members are responsible for the majority of elder mistreatment cases. The elderly can experience mistreatment from home health aides and hospital staff and at adult day care centers, but these don't happen as often.

A nurse is caring for a patient in the emergency department who is the victim of elder mistreatment. Which member of the health care team would the nurse consult first? 1 Physician 2 Social worker 3 Forensic nurse 4 Adult Protective Services

3 - Forensic nurse A forensic nurse collects evidence and gives testimony in a court of law. It is critical to have the victim assessed by the forensic nurse as soon as possible so as not to lose any potentially valuable evidence. The physician manages the medical aspect of the patient's needs. Social workers and Adult Protective Services can assist the health care team in placing the patient in a safe place. These consults are part of the plan of care, but collecting any evidence is a critical first step.

The nurse is caring for a patient brought from home by his or her spouse. The patient's clothing is torn and dirty. The patient does not appear to have been recently bathed. The nurse suspects elder mistreatment (EM). Which nursing action is a priority? 1 Ordering a high-protein dietary tray for the patient 2 Asking the nurse assistant to help bathe the patient 3 Preserving physical evidence of dirty, torn clothing 4 Obtaining current contact information for the spouse

3 - Preserving physical evidence of dirty, torn clothing Preserving physical evidence of dirty, torn clothing may help to prove EM. Dietary preferences and restrictions must be assessed before ordering a dietary tray. The patient should be bathed only after necessary physical evidence and tests are completed. Obtaining the spouse's contact information is not a priority.

What type of elder mistreatment (EM) is exhibited when a caregiver medicates an older adult who exhibits restlessness and expresses fear of hospitalization considered? 1 Overmedication 2 Undermedication 3 Substance abuse 4 Chemical restraint

4 - Chemical restraint Initially administering medication in an older adult who is restless and expresses fear of hospitalization is considered use of a chemical restraint. A thorough assessment for the restlessness and therapeutic communication should be implemented first. Under- or overmedicating an older adult is a form of mistreatment, but in this case there is no information to indicate the older adult is already on medication. Substance abuse is the harmful use of a substance such as drugs or alcohol.

While working in an extended care facility, the nurse witnesses a nurse assistant tell a confused patient, "If you can't quit scratching that sore on your leg, I'm going to have to tie your hands down." What is the most appropriate nursing action? Select all that apply. 1 Ensuring someone else witnesses the behavior of the nurse assistant 2 Letting the nurse assistant know you need to notify the Director of Nursing 3 Doing nothing as this is appropriate care and behavior with a confused, older patient 4 Confronting the nurse assistant in a nonjudgmental way after he or she exits the room 5 Providing education to the nurse assistant on the topic of elder mistreatment (EM)

4 - Confronting the nurse assistant in a nonjudgmental way after he or she exits the room 5 - Providing education to the nurse assistant on the topic of elder mistreatment (EM) Waiting until the nurse assistant exits the room to confront him or her in a nonjudgmental way helps to preserve a working relationship. Even with confusion, ensuring the conversation takes place outside the room prevents the patients from worrying about the level of care and competence of the nursing assistant. Educating on the topic of EM may help to change behavior. Doing nothing is not appropriate, as threatening to tie a patient's hands down is not acceptable behavior for scratching. There are alternative methods to try, such a covering the sore, tucking in the blankets, and using mitts. The Director of Nursing needs to be notified of the situation if this continues, because a facility may lose their license with this type of incident. Notifying at this time would not help preserve the working relationship between the nurse and nurse assistant, and the patient is safe. It is up to the Director of Nursing to provide a performance improvement plan that may include documenting if other employees have witnessed this behavior.

Which of the following best describes elder mistreatment (EM)? 1 An attorney must be involved to classify as EM. 2 At least two incidents must occur to be termed EM. 3 EM is an unintentional act that causes harm to the elderly. 4 EM is an intentional act that causes risk of harm to the elderly.

4 - EM is an intentional act that causes risk of harm to the elderly. An intentional act that causes a risk of harm to the elderly is classified as EM. An attorney does not need to be involved for an act to be classified as EM. The act must be intentional and may include acts of omission or commission. There is no number of minimum incidents that must occur; each incident would be considered EM.

What is the term for intentional acts of omission or commission by a caregiver or "trusted other" that cause harm or risk of harm to a vulnerable older adult? 1 Ageism 2 Self-neglect 3 Ethnogeriatrics 4 Elder mistreatment

4 - Elder mistreatment Intentional acts of omission or commission by a caregiver or "trusted other" that cause harm or risk of harm to a vulnerable older adult is known as elder mistreatment. Ethnogeriatrics describes the specialty area of providing culturally competent care to older adults. Self-neglect occurs when the older adult is unable to meet basic needs and refuses help, has multiple untreated medical or psychiatric conditions, and lives alone, often in squalor. Ageism is an attitude based on age that can lead to negativism and disparities in the care given to the older adults.

A 73-year-old female patient presents with pressure ulcers on her tailbone and heels and appears frail and underweight. The patient seems withdrawn and says she has been moved between family members after her daughter, her primary caregiver, lost her job. What should the nurse consider beyond the patient's immediate health needs? 1 The patient's development of balance issues 2 The patient's adherence to her medication schedule 3 The patient's likelihood of developing Alzheimer's disease 4 The likelihood that the patient is a victim of elder mistreatment (EM)

4 - The likelihood that the patient is a victim of elder mistreatment (EM) The patient's pressure ulcers, low weight, and depression may be signs that she is being neglected, which is a form of elder mistreatment (EM). Successful recognition of EM requires a nurse to dig beyond the standard health checklists. Alzheimer's disease, adherence to medication, and balance issues are important issues for older adults but would not be a priority concern if EM is suspected.